Who should get the COVID-19 vaccine first?
Team of global experts offer a model that would prioritize reducing
premature deaths

Date:
September 3, 2020
Source:
University of Pennsylvania School of Medicine
Summary:
Nineteen global health experts from around the world have proposed
a new, three-phase plan for vaccine distribution -- called the
Fair Priority Model -- which aims to reduce premature deaths and
other irreversible health consequences from COVID-19.



FULL STORY ========================================================================== [Coronavirus vaccine | Credit: (c) Dmytro S / stock.adobe.com] Coronavirus vaccine concept (stock image).

Credit: (c) Dmytro S / stock.adobe.com [Coronavirus vaccine | Credit:
(c) Dmytro S / stock.adobe.com] Coronavirus vaccine concept (stock image).

Credit: (c) Dmytro S / stock.adobe.com Close When effective COVID-19
vaccines are developed, their supply will inevitably be scarce. The
World Health Organization (WHO), global leaders, and vaccine producers
are already facing the question of how to appropriately allocate them
across countries. And while there is vocal commitment to "fair and
equitable" distribution, what exactly does "fair and equitable" look
like in practice?

==========================================================================
Now, nineteen global health experts from around the world have proposed
a new, three-phase plan for vaccine distribution -- called the Fair
Priority Model - - which aims to reduce premature deaths and other
irreversible health consequences from COVID-19. Published this week in
Science, the paper was led by Ezekiel J. Emanuel, MD, PhD, vice provost
for Global Initiatives and chair of Medical Ethics and Health Policy in
the Perelman School of Medicine at the University of Pennsylvania.

Though little progress has been made to describe a single, global
distribution framework for COVID-19 vaccines, two main proposals have
emerged: Some experts have argued that health care workers and high-risk populations, such as people over 65, should be immunized first. The WHO,
on the other hand, suggests countries receive doses proportional to
their populations.

From an ethical perspective, both of these strategies are "seriously
flawed," according to Emanuel and his collaborators.

"The idea of distributing vaccines by population appears to be an
equitable strategy," Emanuel said. "But the fact is that normally,
we distribute things based on how severe there is suffering in a given
place, and, in this case, we argue that the primary measure of suffering
ought to be the number of premature deaths that a vaccine would prevent."
In their proposal, the authors point to three fundamental values that
must be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged,
and giving equal moral concern for all individuals. The Fair Priority
Model addresses these values by focusing on mitigating three types of
harms caused by COVID-19: death and permanent organ damage, indirect
health consequences, such as health care system strain and stress,
as well as economic destruction.

Of all of these dimensions, preventing death -- especially premature
death - - is particularly urgent, the authors argue, which is the focus
of Phase 1 of the Fair Priority Model. Premature deaths from COVID-19
are determined in each country by calculating "standard expected years of
life lost," a commonly-used global health metric. In Phase 2, the authors propose two metrics that capture overall economic improvement and the
extent to which people would be spared from poverty. And in Phase 3,
countries with higher transmission rates are initially prioritized,
but all countries should eventually receive sufficient vaccines to halt transmission -- which is projected to require that 60 to 70 percent of
the population be immune.

The WHO plan, by contrast, begins with 3 percent of each country's
population receiving vaccines, and continues with population-proportional allocation until every country has vaccinated 20 percent of its
citizens. Emanuel and his coauthors argue that, while that plan may
be politically tenable, it "mistakenly assumes that equality requires
treating differently-situated countries identically, rather than
equitably responding to their different needs." In reality, equally
populous countries are facing dramatically different levels of death
and economic devastation from the pandemic, they say.

The authors also object to a plan that would prioritize countries
according to the number of front-line health care workers, the proportion
of the population over 65, and the number of people with comorbidities
within each country. They say that preferentially immunizing health care workers -- who already have access to personal protective equipment (PPE)
and other advanced infectious disease prevention methods -- likely would
not substantially reduce harm in higher-income countries. Similarly,
focusing on vaccinating countries with older populations would not
necessarily reduce the spread of the virus or minimize death. Moreover,
low- and middle-income countries have fewer older residents and health
care workers per capita than higher-income countries.

"What you end up doing is giving a lot of vaccine to rich countries,
which doesn't seem like the goal of fair and equitable distribution,"
Emanuel said.

The authors conclude that the Fair Priority Model is the best embodiment
of the ethical values of limiting harms, benefiting the disadvantaged,
and recognizing equal concern for all people.

"It will be up to political leaders, the WHO, and manufacturers to
implement this model," Emanuel said. "Decision-makers are looking for a framework to ensure that everyone throughout the world can be vaccinated,
so that we can stop the spread of this virus." Other institutions
involved in work include the University of Denver, Princeton University, University of Arizona, University of Oxford, University of Melbourne, University of Toronto, University of Groningen, University of Manitoba,
Jobs Creation Commission of Ethiopia, Facultad Latinoamerica de Ciencias Sociales (FLACSO) in Argentina, University of Bergen, Norwegian Institute
of Public Health, National University of Singapore, Washington University
in St. Louis, and Georgetown University.


========================================================================== Story Source: Materials provided by University_of_Pennsylvania_School_of_Medicine. Note: Content may be
edited for style and length.


========================================================================== Journal Reference:
1. Ezekiel J. Emanuel, Govind Persad, Adam Kern, Allen Buchanan,
Ce'cile
Fabre, Daniel Halliday, Joseph Heath, Lisa Herzog, R.J. Leland,
Ephrem T.

Lemango, Florencia Luna, Matthew S. McCoy, Ole F. Norheim,
Trygve Ottersen, G. Owen Schaefer, Kok-Chor Tan, Christopher
Heath Wellman, Jonathan Wolff, Henry S. Richardson. An ethical
framework for global vaccine allocation. Science, Sept. 3, 2020;
DOI: 10.1126/science.abe2803 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/09/200903145011.htm

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